S 0742 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRIC.I, P151T NO.
BUILDING DIVISION APPLICATION/1'RRMIT PLUMBING-MECHANICAL' _ J 0742
BUILDING PROJECT 11I6Y1'INIGTION
len
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMI'UAL DATE
O R'S NAME: PHONE: CO TRA DR'S li: LIC NO.
J'M 3 NIC CONTROI,x
CHITECTMNGINEER: LIC NO: ADDRESS: ' o ❑
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLD ELLE I' PLUME . MEC,
LICENSED CONTRACTOR'S DECLARATION QTY. ELFCTRICPERMIT FEE
I barchy m that 1 not reen.ed ander......it of chapter q Utemmnaag _. JOB DESCRIPTION
a9z with S.linn)Mal.fDi,i1um 3,,1 tire Bnsincesand Prousliuns Cada,:mdory license is RESIDENTIAL'
LLT
0, PERMIT ISSI/ANCE
F W s' 'm full fares and elle ❑SFD)VL ❑KITCHEN REMODEL
tFz�j License-yF Co. 7, APPLIANCES-RESIDENTIAL ❑ADUII'ION ❑PLUMBING RC-PIPE
NGi Dae Conuaztnr�
ARCHIt1iC1'S DECLARA 1 N ❑MULTI-UNIT ❑STRUCI'URAL
F,O y PANELS MODIFICATION
2 O 7J. I unJcrsmnd my plans shall Mused es public arnNs UP TO 2(x1 AMPS
OZ—� ❑IN'I'IiR10R El CHIMNEY REPAIR
a4 IA Licensed Pmfcesionul 201-1(MAMPS IMPROVEMENT []SWIMMING POOLS
ag�CJJ OWNER-BUILDER DECLARATION
OVER IOW AMPS ❑HATH KEMUDh:IJKliI'AIR ❑ EMOLITION
Q 1 M1erchy.(firm that I am exempt from the Cosma, rit License city
for the
MOW which requires
Permit to
Business and Professions Critic:Any city orcnunre SIGNS[LECI'RICAi. ❑OTHER _
YJ
E:01
O 1 which requites a permit re cursed.her,improve.for such
h Earmsh m repair any swemre
prior to issuance,also requires the applicant for such parmino file nsigned ueemem SPECIAL CIRCUIT'/MISC.
6 5+ that he is liccmed mrsuanno the pmvismins of the Camow art's License Ute(Chapter 9
(a......airgwith Section 7WOnnDNVl..an 3 ofthe limina..and Prated..,G'de)or TEMP.METBR OR POLE 11,11COMMERCIAL,11h,
that he is exempt therefrom and the took far the alleged exemption.Any violation of El NEW BLDG/ADDITION ❑DEMOLITION
uXl 4' Section]031.5 by any applicarnfor a permit subjects the applicant m a civil penalty of POWERDEVICES [I TENANT ❑FOOD SERVICE
not more than five hundred dollen(S50R.
F_Z> IMPROVEMENT
Tp l]Lo newer of the pe dateline
oithwred for aleirsMe compensation, SWIMMING E
is ill do the work,and lheswcmrc is not intended or offered for sale(Sec.]f W1,Business �OIIII°R
LLl and Prnf..=Code:The Convector's License law Anes not...ly it,an owner of OUTT. S W IT 'S X IiS
property who hinds or improve,thuum,and who Jncs such work himself or through
his own candoyccs,provided that such improvements are not intended h onched for as 4 bLW1iSIUT40LEC% SQ FT.
sale.If.however.the building or improvement is sold within one year of completion the SQ.FT FLOOR AREA SISQ.FT.
owneothuilder will have me burden of proving that he dirt not build or improve for
pose of solo.). '
❑1,as owner of the progeny,am exclusite)y contracting with licensed coulraztnr.t TOTAL:
consumer the project(Sec.](44,Business and Pmfe,ions Cade:)The Contractors Li- -
waseLowAnesnotapplytoanownerofpropenywhobuildsorimpmvcstnacon,and Y. PI,UMBING PERMIT FEE
who convects for such projects with.contractor(s)licensed pursuant to the Contractor's
License Law. ;RMIT ISSUANCE
❑ I am exempt under Sec. ,B&P C for this reason
Data
ACIER-DRAIN&VENT-WATER IFA) VALUATION
er
WORKER'S COMPENSATION DECLARATION BACK FLOW PRY ECT DEVICE
1 hereby affirm under Ex mdty of perjury me oT the following dalnnnlnns:
❑I have and will maintain a Cenificae of Conscrfto vadFinsure fin-Worker s Compen- DRAINS-FLOOR.ROOP.AREA,XO ND' STORIES TYPE CONSTRUCTION
satin..he provided for by Section 377)of the Labor Code,for the peroura nce of me
work for which this permit is issuer. FIXTURES-P17R TRAP
❑I have and will maintain Wm1wA Compewatien Invarance,as required by Section
37W of rise Labor Cocaforthe strfmm.nce of the work for which this permit is tared. GAS-EA.SYSTEM-I INC.40 6wisiv FICC.GROUP APN
My Works s m pensaran ins mace eerier entl Policy h rtrc
Grticn �Pnncy No.:991FfA/f MS-EA.SYSD?MOVER 4(I.
CERTIFIC OI' AM
N FROM WORKERS' GREASOINDUS'I'RL WASTE 1 'ER
COMYIiNSASATET10N INSURANCE. BUILDING DIVISION FEES
(This section need not be completed ifthe Permit isfncruchundreddollan(STU)) GREASE TRAP
or IesJ PLANCIIECK HE
I cenifythm inure performance of the rote fmwhich lhisperhadis issued,Ishall SEWER-SANITARY-STORM IIA.2(X)ET.
nm employ any person in any manner so as to become,,nhject m the Wntkar,Compen- ENERGY FEE
Z sation Laws of California.Dae WATER DEAI'HR W/VENT/ELECI'It
OQ Applicant f GRAVING FEE
NOTICE TO APPLICANT:If,afar makirg this Cenificae of Exemption,You should WATER SYSTEMO KEATING
a ? berome subject y with
Workers Compensation ptord i hal of the Lahr voka you must 5011.5 PCE
D-1 forthwith comply with such provisions or perm.shallbodeemed revnAcJ. WATER SERVICE?
a
CONhem isa t harENDINGAGENCY NEW RESIDENTIAL 1'LMB. SQ.FT. PAID
Iherehy ufOnn dmuherc isnnmstraction lending agency far the perfonnunce of D,IZ Iteeoipt#
U� the work for which this emit is is,ued(Sec.30W,Civ.C.)
Lender's Name TOTAL.
Lender's Address TOTAL:
1 sanity than I have read this application and state that the above information isBIIILDINC P
IZ) correct.l agree to comply with all city and county ordinances and state laws relining to QTY. MECHANICAL PPRN NEE.
U building contractor,and M1erchy a uthoriveremescnlmlvesofthis aq,tarerupmt the SEISMIC FF..
r above-mantloned property finurpwtion purpoeoe.
(W.)agree to save, ndemnily and kap handles the City of Cupertino ugaina I'ENMIT ISSUANCE BI.ECHIIC PEE
liabilities,judgments.costs and expense which may in any way wean almost said City ALT ER OR ADD'I0 MEECH. PLUMIIING HE
r1
in consequence of the grapermit. —
nting of this pet.
se / {.!
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.07l
SOU CE REGUGT NS. MECHANICAL I'EE
iYJ'l�l�`� 1/Z9/ AIR HANDLING ON]F(OVER 10,000CFM) CONSI'RUC'1'IONTAX
SI name o mrCo Irwma — isQQ HXHAUSTHOOD(W/DUCT)
410USING MITIGATION I'IiF.
HAZARDOUS MATERIALS DISCLOSURE
Willthe applicant or furore building apt store 2.handle hearths Creedal HEATING UNIT('TO l M."XIO BTU)
as defined by the Cupertino Municipal Code,
e,ChCM1aper a.12.and the Health and SafetyCada Section 2551$e)] HEATING UNIT(OVER 1 W,IXN)BTU)
❑Yes Fl No VRNTILATION FAN(SINGLE RE'SID) PAID
Date Receipts
Will the applicant or furore re Wing occupant yA equipment or devices which
mit hamrrnus air contaminants as refined by the Bay Arca Air Quality Management BOILER-COMP I3HP OR IIM),fNMI BTU)
TO AL
District?
C3 Yes ❑Nn (X1MOILER-COME'(OVER 100, 0 BTU)
1 have read the haaaNnus materials regriremcros under Chapter b.95 it oto Cali- AIR CONDITIONER ISSUA CED �x
forma Health&Safety Cada,Section,25505,25533 and 25534.1 understand that if the N17W RESIDEN'I'[A],MECH SQ.FT. 2• -� }�
building does not currently have a tenant,that it is my respimsibility ut ratify the occupant V
of tiera� drams whicr� t t dorm.a��unce a is Cenificri nf(lee� per
/coat, ! \al // 9l)/9Y -- p
Ussattir a�hnnaed agent ���— T(ITAL: �.�7[J ISSUED BY: d8�
OFFICE
®? 10300 Torre Avenue
Cupertino, CA 95014
Cita• of
Cupertino Building Division
(408)777-3333 (fax)
February 9, 1999
Homeowner
" 10017 Scenic Road
Cupertino, CA 95014
SUBJECT: Permit#S0742
Dear Homeowner:
We have been going through our files in the Building Department, and contacting those
people with permits remaining "open".
c• According to our inspection records, this permit has not been signed off by the Building
Department. Many times an inspector will sign the permit in the field, but overlook
reporting all of the information to the clerical staff for input into the computer. If this is
the situation and your permit card shows the final sign-off, would you please contact us
so we may complete our computer records? If the permit is not signed off, please call to
schedule an inspection for final closure of the permit.
Because of the large volume of paperwork within the building department, we cannot
separately monitor the progress of each permit. We ask that you give this notification
your immediate attention. If we do not hear from you within ten (10) working days we
will remove the records from our computer.
Thank you for your assistance.
Sincerely,
CITY O CUPEERTTIINO
Christy Akatiff, Administrative Clerk
i
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